Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX.
Department of Otolaryngology, UT Southwestern Medical Center, Dallas, TX.
JCO Clin Cancer Inform. 2022 Mar;6:e2100179. doi: 10.1200/CCI.21.00179.
Given the established associations between performance status and survival in a variety of cancers, there is significant interest in using a biometric wearable device (WD) to predict outcomes in the oncology population. In this pilot study, we investigated the ability of a WD to predict meaningful clinical end points in patients undergoing head and neck radiotherapy.
Patients receiving head and neck definitive chemoradiotherapy or postoperative radiotherapy/chemoradiotherapy were enrolled in this pilot study, designed to show 90% compliance with using the device. Individuals were asked to wear the WD for 23 hours a day, and hospital admissions, pain medication usage, and FACT-G quality-of-life (QoL) score were prospectively recorded.
Fifty-one patients were enrolled and started using the WD, but eight patients stopped wearing it, resulting in a compliance probability of only 84%. There were 15 hospital admissions, 13 of which were planned for feeding tube placement. There was no step count threshold that predicted the need for admission or more pain medications. However, among the 25 patients with a significant reduction in FACT-G score, the average reductions in daily steps during the week and weekend before the decline were 988 ( = .005) and 1,311 ( = .018), respectively, and the odds of a QoL reduction were more than 4-fold higher among patients experiencing a week-to-week reduction of at least 1,000 daily steps. There was no association between heart rate and any end point.
Although not meeting the compliance goal, the majority of patients did use the WD. The WD signal could not identify patients requiring hospitalization or significantly more pain medication, but the finding of reduced step counts before a significant reduction in QoL is provocative.
鉴于在多种癌症中，表现状态与生存之间存在既定关联，因此人们对使用生物计量可穿戴设备（WD）来预测肿瘤患者的结局产生了浓厚的兴趣。在这项初步研究中，我们调查了 WD 预测接受头颈部放射治疗的患者有意义的临床终点的能力。
本初步研究纳入了接受头颈部根治性放化疗或术后放疗/放化疗的患者，旨在显示使用该设备的 90%的依从率。要求患者每天佩戴 WD23 小时，并前瞻性记录住院、止痛药使用情况和 FACT-G 生活质量（QoL）评分。
共纳入 51 例患者并开始使用 WD，但有 8 例患者停止佩戴，依从概率仅为 84%。有 15 例住院，其中 13 例是计划放置喂养管。没有达到预测需要住院或使用更多止痛药的步数阈值。然而，在 FACT-G 评分显著下降的 25 例患者中，下降前一周和周末每日步数减少的平均值分别为 988（=0.005）和 1311（=0.018），且 QoL 下降患者的每周至少减少 1000 步的几率是其他患者的 4 倍以上。心率与任何终点均无关联。
尽管未达到依从性目标，但大多数患者确实使用了 WD。WD 信号无法识别需要住院或使用更多止痛药的患者，但发现 QoL 显著下降前的步数减少令人深思。
